chapter1 Introduction to clinical laboratory.pptx

this chapter is about stool analysis and how to anaylse viewfeuses. it gives overview of stool analysis, using microscopic and chemical analysis

1. Clinical laboratory Abdirashid Jama Guure (BSc. MSc)

2. clinical laboratory or A medical laboratory A medical laboratory or clinical laboratory is a laboratory where clinical pathology tests are carried out on clinical specimens to obtain information about the health of a patient to aid in diagnosis, treatment, and prevention of disease. [ Clinical Medical laboratories are an example of applied science, as opposed to research laboratory that focus on basic science, such as found in some academic institutions .

3. Medical laboratories vary in size and complexity and so offer a variety of testing services. More comprehensive services can be found in acute-care hospitals and medical centers, where 70% of clinical decisions are based on laboratory testing. Doctors offices and clinics, as well as skilled nursing and long-term care facilities, may have laboratories that provide more basic testing services. Commercial medical laboratories operate as independent businesses and provide testing that is otherwise not provided in other settings due to low test volume or complexity.

4. If the entire network of a laboratory service is to be effectively utilized and contribute to health care and disease prevention, every member of its work force need to: Understand the role of the laboratory and its contribution to the nation’s health service; Appreciate the need to involve all members in the provision of health service; Follow professional ethics and code of conduct; Experience job satisfaction and have professional loyalty.

5. Introduction to Medical Laboratory Technology is a basic course that equips the student with the most essential knowledge and skill pertaining to medical laboratories such as: Importance of laboratory services; Role of medical laboratory technologist; Use of laboratory wares, instruments and sterilization techniques; Prevention and control of laboratory accidents and; Institution of quality control system.

6. History of Medical Laboratory Science It is difficult to exactly say when and where medial laboratory science was started. However, some early historical references have shown that there was examination of body fluid around the era of Hippocrates. The most important event that contributes for the development of the profession was the discovery of microscope by a German scientist Antony Van Leoun Hook

7. Previously one cannot talk about the field of medical laboratory science without also talking about the medical specialty of pathology. Early laboratory practioners were physicians, pathologists or both. But sooner medical laboratory profession was developed into a separate discipline having its own educational requirements and standards.

8. General overview Laboratory is a place that is equipped with different instruments, equipments and chemicals (reagents) etc., for performing experimental works, research activities and investigative procedures. Medical laboratory is one part of the laboratory that is equipped with various biomedical instruments, equipments , materials and reagents (chemicals) for performing different laboratory investigative activities by using biological specimens (whole blood, serum, plasma, urine, stool, etc ).

9. It is important to understand that biological agents are classified in a graded fashion such that the level of hazard associated with RG1 being the lowest and RG4 being the highest RG1 – Are not associated with disease in healthy adult humans or animals RG2 – Are associated with disease which is rarely serious and for which preventative or therapeutics is often available RG3 – Are associated with serious or lethal human disease for which preventative or therapeutics may be available RG4 – Are associated with lethal human disease for which preventative or therapeutics are not readily available

10. Classification of medical laboratories The world Health Organization (WHO) lists four kinds of levels of laboratories based on their biosafety 1:Basic laboratory level I Basic laboratory level I is the simplest kind and adequate for work with organisms which have low risk to the individual laboratory personnel as well as to the members of the community. Such organisms are categorized under Risk Group I by WHO. These organisms are unlikely to cause human diseases. Example, food spoilage bacteria, common molds and yeasts.

11. 2: Basic laboratory level II Basic laboratory level II is suitable for work with organisms that predispose to moderate risk to the laboratory worker and a limited risk to the members of the community. Such organisms are categorized under Risk Group II by WHO. They can cause serious human diseases but not serious hazards due to the availability of effective preventive measures and treatment. Example, staphylococci, streptococci, entero bacteria except Salmonella typhi and others. Such laboratory should be clean, provide enough space, have adequate sanitary facilities and equipped with autoclave.

12. 3: Containment laboratory (Level III) Containment laboratory is more advanced and it is used for work with infectious organisms that present a high risk to the laboratory personnel but a lower risk to the community. Such organisms are categorized under Risk Group III by WHO. Example , Tubercle bacilli, Salmonella typhi, HIV, Yersina and others. The principle is to remove from the basic laboratory those organisms and activities which are particularly hazardous. They are easily transmitted through airborne, ingestion of contaminated food or water and parenterally. Such laboratory should be a separate room with controlled access by authorized staff.

13. 4: Maximum containment laboratory Maximum containment laboratory is intended for work with viruses, which predispose to a high risk for both laboratory personnel and the community. Such organisms are categorized under Risk Group IV by WHO. Example, Small pox , Ebola, Lassa fever and others. Most of these organisms cause serious disease and readily transmitted from on person to another. These laboratories are usually a separate building with strictly controlled access.

14. Laboratory organization Organization: - is a system, an orderly structure, putting things together into a working order, and making arrangements for undertakings that involve cooperations .

15. Cont.. The emphasis is on arrangements that enable peoples working together and accomplishing common objectives in an efficient, planned and economic manner. In a single medical laboratory at least there are two interlocking components of organizations. These are laboratory head and other staff having their own duties and responsibilities

16. S tructure of medical laboratory services 1. Community based primary health care laboratory. Duties To support primary health care in investigating, controlling and preventing major diseases in the country. Promoting health care by integrated health education

17. Main activities are to: Investigate by referral or testing on site, important diseases and health problems affecting the local community. Such investigations usually include bacterial diseases, parasitic diseases and other causes of illness. Assist health care worker in deciding the severity of a patient’s conditions.

18. Collect and refer specimens for testing to the district laboratory. Notify the district hospital at an early stage of any laboratory results of public health importance and send specimens for confirmatory tests. Screen pregnant women for anemia, proteinuria, malaria, HIV/AIDS , HBV, HCV and refer serum for antibody testing. Promote health cares and assists in community health education

19. Keep records, which can be used by health authorities in health planning and for epidemiological purposes. • Send an informative monthly report to the district hospital laboratory.

20. 2. District hospital laboratory Duties: In addition to the works stated above, these laboratories have an important role in supervising the work of the peripheral community based laboratories, testing referred specimens, and performing a range of tests compatible with the work of district hospital

21. Main activities are to: Perform a range of tests relevant to the medical, surgical, and public health activities of the district hospital. Support the work of the community-based laboratories by testing referred specimens, providing reagents, controls, standards, specimen containers, and other essential laboratory supplies. And also visit each primary health care laboratory in their catchments area to inspect and discuss the investigations being performed and, comment on their quality assurance system, record keeping, safety procedures, as well as the status of equipment maintenance.

22. Cont.. Refer specimens to the regional laboratory for test (s) that cannot be performed in district laboratory. Notify the regional laboratory of any result of public health importance and to send specimens for confirmatory tests. Participate in the external quality assurance programme organized by the regional laboratory. Prepare and send periodical reports to the regional laboratory.

23. 3 Regional hospital laboratory Duties: In addition to the duties done at the two above lower levels, the regional laboratory assists and supervises the district laboratories. It analyses referred specimens and performs a range of specialized and other tests as required by the work of the regional hospital

24. Main activities are to: • Operate a regional blood transfusion center; • Prepare reagents, controls, standard solutions and others as found necessary; • Investigate epidemics and perform tests of public health importance in the region; • Supervise and support the work of district laboratories; • Send specimens that require special investigation to the central and public health laboratory; • Prepare periodical reports and send to the central and public health laboratory.

25. 4. Central and public health laboratory The central and public health laboratory is responsible for planning, advising and overall coordinating of medical laboratory services in the region.

26. Main activities are to: • Formulate a professional code of conduct to medical laboratory personnel. • Perform a range of special tests not normally undertaken in the regional laboratories such as viral, histopathological, cytological, immunological, forensic and genetic investigations.

27. Cont.. • Carry out appropriate research of importance in order to mitigate public health problems. • Evaluate new technologies and standardize techniques. • Purchase supplies and equipments for the national laboratory service and organize an efficient system of requisition, distribution, and maintenance of equipment.

28. Cont.. Communicate and collaborate with International Organizations in promoting laboratory standards. Organize laboratory-teaching seminars and prepare training manuals for the different laboratory-training programmes . Support the work of the regional hospital laboratories. Organize refreshment training and seminars/ workshops for district and primary health care laboratory personnel.

29. Cont.. Prepare training manuals for the different laboratory training programmes . Participate in the prompt laboratory investigation of epidemics and outbreaks of serious illness among communities.

30. Role of medical laboratory services The medical laboratory services play a pivotal role in the promotion, curative and preventive aspects of a nation’s health delivery system. The service gives a scientific foundation by providing accurate information to those with the responsibility for:

31. Treating patients and monitoring their response to treatment, Monitoring the development and spread of infectious and dangerous pathogens (disease causing organisms), Deciding effective control measures against major prevalent disease, Deciding health priorities and allocating resources.

32. Without reliable laboratory services: 1. The source of a disease may not be identified correctly. 2 Patients are less likely to receive the best possible care. 3. Resistance to essential drugs may develop and continue to spread. 4. Epidemic diseases may not be identified on time and with confidence.

33. Role of medical laboratory technologist Some of the major roles of medical laboratory technologist are to: Carry out routine and advanced laboratory tests using standard laboratory methods; Apply problem-solving strategies to administrative, technical and research problems; Conduct community – based researches in collaboration with other categories of health professionals; Provide professional consultancy on matters related to the establishment, renovation, upgrading and reorganization of medical laboratories of intermediate levels.

34. Medical laboratory rules, ethics and professional code of conduct Rules of medical laboratory A. Medical Laboratory request form Many different types of laboratories requests are received daily in a medical laboratory. The format of laboratory requisitions may vary from one health institution to the other. In many health institutions, the test request form serves as a test result report form. An efficient laboratory will be able to monitor the laboratory request and its requisition forms from the time the specimens arrive until the time that results are released.

35. Laboratory request form should be made in writing and provide the following information: The patients identification (full name, age, sex, address); Inpatient or out patient identification number; Specific test(s) required and date requested; Type of specimen provided; Name of medical officer requesting the test and to whom the report should be sent; Any other information relevant to the test requested.

36. B. Keeping of laboratory records The laboratory must keep a record of all results and it should contain: Patient’s identification (name, age, sex, full address), Type of the specimen (s), Type of test(s) done, Date and result(s) of the test (s).

37. C. Delivery of laboratory results Laboratory staff should provide as much relevant information as possible to assist those requesting tests. Standardization in the presentation of reports and use of units is important because it helps in the interpretation and comparison of results, contributes to the efficiency of a laboratory service, and is of great value when patients are referred from one health unit or hospital to another. Reports should be clearly and neatly written, particularly figures.

38. Therefore, to ensure the validity and accuracy of test results, the following points should be taken into consideration. Experienced member of medical laboratory professional must check all laboratory results before dispatching them to respective departments or units. Any unexpected result should be investigated and repeated if necessary. If possible, reference values (normal ranges) should be included in reports.